title: Response to endoscopic therapy for biliary anastomotic strictures in deceased versus living donor liver transplantation.
abstract: BACKGROUND
  Endoscopic therapy has been successful in the management of biliary complications after both deceased donor liver transplantation (DDLT) and living donor liver transplantation (LDLT). LDLT is thought to be associated with higher rates of biliary complications, but there are few studies comparing the success of endoscopic management of anastomotic strictures between the two groups. This study aims to compare our experience in the endoscopic management of anastomotic strictures in DDLT versus LDLT.
  
  
  METHODS
  This is a retrospective database review of all liver transplant patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) after liver transplantation. The frequency of anastomotic stricture and the time to develop and to resolve anastomotic stricture were compared between DDLT and LDLT. The response of anastomotic stricture to endoscopic therapy was also analyzed.
  
  
  RESULTS
  A total of 362 patients underwent liver transplantation between 2003 and 2011, with 125 requiring ERCP to manage biliary complications. Thirty-three (9.9%) cases of DDLT and 8 (27.6%) of LDLT (P=0.01) were found to have anastomotic stricture. When comparing DDLT and LDLT, there was no difference in the mean time to the development of anastomotic strictures (98+/-17 vs 172+/-65 days, P=0.11), likelihood of response to ERCP [22 (66.7%) vs 6 (75.0%), P=0.69], mean time to the resolution of anastomotic strictures (268+/-77 vs 125+/-37 days, P=0.34), and the number of ERCPs required to achieve resolution (3.9+/-0.4 vs 4.7+/-0.9, P=0.38).
  
  
  CONCLUSIONS
  Endoscopic therapy is effective in the majority of biliary complications relating to liver transplantation. Anastomotic strictures occur more frequently in LDLT compared with DDLT, with equivalent endoscopic treatment response and outcomes for both groups.
authors.affiliation: Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada. fdonnellan77@hotmail.com.
authors.forename: Calvin H Y
authors.initials: CH
authors.lastname: Chan
authors.forename: Fergal
authors.initials: F
authors.lastname: Donnellan
authors.forename: Michael F
authors.initials: MF
authors.lastname: Byrne
authors.forename: Alan
authors.initials: A
authors.lastname: Coss
authors.forename: Mazhar
authors.initials: M
authors.lastname: Haque
authors.forename: Holly
authors.initials: H
authors.lastname: Wiesenger
authors.forename: Charles H
authors.initials: CH
authors.lastname: Scudamore
authors.forename: Urs P
authors.initials: UP
authors.lastname: Steinbrecher
authors.forename: Alan A
authors.initials: AA
authors.lastname: Weiss
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome